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Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa
Background: Colorectal cancer (CRC) is the second leading cause of cancer mortality globally, with an increasing burden in low- and middle-income countries (LMICs) like South Africa. CRC, often accompanied by stoma formation, imposes significant out-of-pocket (OOP) expenses for patients. However, li...
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| Format: | Thesis |
| Language: | English English |
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2026
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| _version_ | 1869483652754178048 |
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| access_status_str | Open Access |
| author | Gokool, Kairav |
| author2 | Cunnama, Lucy |
| author_browse | Cunnama, Lucy Gokool, Kairav |
| author_facet | Cunnama, Lucy Gokool, Kairav |
| author_sort | Gokool, Kairav |
| collection | Thesis |
| description | Background: Colorectal cancer (CRC) is the second leading cause of cancer mortality globally, with an increasing burden in low- and middle-income countries (LMICs) like South Africa. CRC, often accompanied by stoma formation, imposes significant out-of-pocket (OOP) expenses for patients. However, limited research exists on the financial and socio-economic impacts of CRC and CRC-related stoma care in LMIC contexts. This exploratory study investigated the extent of catastrophic health expenditure (CHE) among CRC patients with stomas and the financial coping strategies they employ. Methods: A cross-sectional observational study was conducted at Groote Schuur Hospital in Cape Town, South Africa, from October to November 2024. A questionnaire was administered to 21 patients with CRC and stomas to gather data on demographics, direct and indirect costs, and coping mechanisms. Statistical analysis included descriptive statistics, computing CHE and penalised logistic regression models to identify determinants of CHE. Cost-coping strategies were also examined. Results: Transportation costs accounted for the largest share of OOP expenditure (48.9%) and followed by medicines (27.8%). CHE, defined as annual OOP costs exceeding 10% of household expenditure, affected 38% of participants, with a disproportionate burden on poorer households and patients with late-stage CRC. Among the poorest households, 60% experienced CHE compared with 50% of poor households, similarly 50% of stage 3 and 33.33% of stage 4 CRC households reported CHE. Financial coping strategies were reported by 81% of households, most commonly reducing household expenditures (47.7%) and taking on additional work (19%). A notable proportion (19%) reported employing no coping mechanisms. Conclusion: This study highlights the significant financial burden faced by CRC patients with stomas. To mitigate this burden, policymakers should prioritize expanding financial protection measures, such as subsidies for essential medications and transport assistance programs. Integrating CRC care into existing universal health coverage (UHC) frameworks can also enhance affordability and accessibility. Adopting early screening initiatives may also play a crucial role in alleviating late-stage disease burdens and the accompanying likelihood of financial catastrophe. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/43345 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-07-01T04:02:24.570Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | Unknown |
| publisherStr | Unknown |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/43345 Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa Gokool, Kairav Cunnama, Lucy Okova, Denis Colorectal cancer CRC Catastrophic Health Expenditure CHE South Africa Stoma Household costs Financial protection Background: Colorectal cancer (CRC) is the second leading cause of cancer mortality globally, with an increasing burden in low- and middle-income countries (LMICs) like South Africa. CRC, often accompanied by stoma formation, imposes significant out-of-pocket (OOP) expenses for patients. However, limited research exists on the financial and socio-economic impacts of CRC and CRC-related stoma care in LMIC contexts. This exploratory study investigated the extent of catastrophic health expenditure (CHE) among CRC patients with stomas and the financial coping strategies they employ. Methods: A cross-sectional observational study was conducted at Groote Schuur Hospital in Cape Town, South Africa, from October to November 2024. A questionnaire was administered to 21 patients with CRC and stomas to gather data on demographics, direct and indirect costs, and coping mechanisms. Statistical analysis included descriptive statistics, computing CHE and penalised logistic regression models to identify determinants of CHE. Cost-coping strategies were also examined. Results: Transportation costs accounted for the largest share of OOP expenditure (48.9%) and followed by medicines (27.8%). CHE, defined as annual OOP costs exceeding 10% of household expenditure, affected 38% of participants, with a disproportionate burden on poorer households and patients with late-stage CRC. Among the poorest households, 60% experienced CHE compared with 50% of poor households, similarly 50% of stage 3 and 33.33% of stage 4 CRC households reported CHE. Financial coping strategies were reported by 81% of households, most commonly reducing household expenditures (47.7%) and taking on additional work (19%). A notable proportion (19%) reported employing no coping mechanisms. Conclusion: This study highlights the significant financial burden faced by CRC patients with stomas. To mitigate this burden, policymakers should prioritize expanding financial protection measures, such as subsidies for essential medications and transport assistance programs. Integrating CRC care into existing universal health coverage (UHC) frameworks can also enhance affordability and accessibility. Adopting early screening initiatives may also play a crucial role in alleviating late-stage disease burdens and the accompanying likelihood of financial catastrophe. 2026-06-22T10:49:12Z 2026-06-22T10:49:12Z 2026 2026-06-22T10:42:00Z Thesis / Dissertation Masters MPH http://hdl.handle.net/11427/43345 en eng application/pdf Unknown Faculty of Health Sciences University of Cape Town |
| spellingShingle | Colorectal cancer CRC Catastrophic Health Expenditure CHE South Africa Stoma Household costs Financial protection Gokool, Kairav Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa |
| thesis_degree_str | Master's |
| title | Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa |
| title_full | Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa |
| title_fullStr | Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa |
| title_full_unstemmed | Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa |
| title_short | Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa |
| title_sort | catastrophic health expenditure and financial coping strategies among patients with colorectal cancer crc and stomas a cross sectional study at groote schuur hospital western cape south africa |
| topic | Colorectal cancer CRC Catastrophic Health Expenditure CHE South Africa Stoma Household costs Financial protection |
| url | http://hdl.handle.net/11427/43345 |
| work_keys_str_mv | AT gokoolkairav catastrophichealthexpenditureandfinancialcopingstrategiesamongpatientswithcolorectalcancercrcandstomasacrosssectionalstudyatgrooteschuurhospitalwesterncapesouthafrica |